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Chapter 10: Promoting Independence in Later Life

Chapter 10: Promoting Independence in Later Life. Bonnie M. Wivell, MS, RN, CNS. Maintaining Independence. Many factors contribute to the ability of older adults to continue their independence Maintaining maximum independence while maintaining maximum QOL.

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Chapter 10: Promoting Independence in Later Life

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  1. Chapter 10: Promoting Independence in Later Life Bonnie M. Wivell, MS, RN, CNS

  2. Maintaining Independence • Many factors contribute to the ability of older adults to continue their independence • Maintaining maximum independence while maintaining maximum QOL

  3. Influences of Environment and Living Situation • Living skills • Kohlman Evaluation of Living Skills • Self-care • Safety and health • Money management • Transportation and phone use • Work and leisure • Housing influences • Assist with decision • Distribution of belongings • Fiscal considerations

  4. Self-Care • Maintaining interests • Doing for others • Frailty: general decline in physical function that may increase vulnerability to illness and decline • Exhaustion • Grip strength • Walking speed • Low caloric expenditure

  5. Role Changes/Transitions • Retirement • Health to illness • Loss of a spouse • Widows/Widowers • Divorce • Role reversal: care provider to care recipient • Driving a car • Strong emotional and psychological implications

  6. Role Changes/Transitions • IADLs = shopping, errands • ADLs = personal care • Caregiving – often needed long before accepted

  7. Caregiving Options • Settings • Senior living complex • Assisted living • Paid caregivers • Extended care facilities • Family • Stressors • Time • Cost • Use of humor can provide stress relief

  8. Socialization • Maintaining connection to others • Relationships • Companionship

  9. PsychoSocial and Spiritual Influences • Stress management • Expression of emotion • Exercise • Deep breathing • Day dreaming/Guided imagery • Progressive relaxation • Meditation • Goal attainment

  10. Maximizing Function • Many factors influence the ability of the older adult to maintain and maximize function • “So you want to live to be 100. Well, start with this: No smoking, no drinking, no chewing. And always clean your plate. Well, you can drink a little bit, but not much!”

  11. Preventing Complications of Existing Illness or Disease • Nutrition • Sleep • Exercise • Fall prevention

  12. Value of Rehabilitation • Goals • Promote independence • Maximize function • Prevent complications • Promote quality of life

  13. Use of/Alternatives to Restraints • Personal strengthening and rehab program • Use of personal assistance devices such as hearing aids, visual aids and mobility devices • Use of positioning devices such as body and seat cushions, padded furniture • Safer physical environment design, including removal of obstacles that impede movement, placement of objects and furniture in familiar places, lower beds, adequate lighting

  14. Use of/Alternatives to Restraints • Regular attention to physical and personal needs, including toileting, thirst, hunger, socialization, and activities adapted to current ability and former interests • Design of physical environment for close observation of staff • Efforts to increase staff awareness of person’s individual needs – including assignment of staff particularly to the person, in effort to improve function and decrease difficult behaviors.

  15. Use of/Alternatives to Restraints • Living environment designed to promote relaxation and comfort, minimize noise, provide soothing music and appropriate lighting • Provision of massage, art, movement activities • Use of bed, chair and door alarms to alert to the need for assistance

  16. Financial Considerations • Help as needed: • Medicare/Medicaid • Food stamps • Grants • Church programs/pantries • AARP and other aging agencies for the state or county

  17. Community Resources • Know what is available in your own community: • Senior centers • Wellness programs through hospitals • Church groups for socialization and support • VNA/Hospice when needed

  18. Community Resources • Problem-based support groups • Meals on Wheels • Geriatric case management • Eldercare facilities • Community clinics

  19. Other Recommendations to Promote Healthy Aging • Eat breakfast every day. • Select high-fiber food like whole grain breads and cereals, beans, vegetables, and fruits. • Have three servings of low-fat milk, yogurt or cheese a day. Dairy products are high in calcium and vitamin D and help keep your bones strong as you age. Or take a calcium and vitamin D supplement.

  20. Other Recommendations to Promote Healthy Aging • Drink plenty of water. You may notice that you feel less thirsty as you get older, but your body still needs the same amount of water. • Ask your health care provider about ways you can safely increase the amount of physical activity you do now.

  21. Other Recommendations to Promote Healthy Aging • Fit physical activity into your everyday life. For example, take short walks throughout your day. You do not have to have a formal physical activity program to improve your health and stay active. • Get enough sleep. • Stay connected with family, friends and community.

  22. Chapter 11: Promoting Healthy Aging Bonnie M. Wivell, MS, RN, CNS

  23. Healthy People 2000 and 2010 Initiatives Purpose: Health promotion Document baselines Set objectives Monitor progress Healthy People 2000 target goals Met for mammogram screening and influenza vaccination Fell short for Pneumococcal vaccination Physical activity, overweight, eating fruits and vegetables Reducing hip fractures, and fall-related deaths Toolkit for HP 2010 available at http://www.health.gov/healthypeople/state/toolkit

  24. Medicare Coverage Nutrition therapy for persons with diabetes and kidney disease An initial physical examination that includes prevention counseling Smoking cessation—for those who have an illness caused by or complicated by tobacco use Comprehensive health promotion programs for beneficiaries with heart problems

  25. Health Behavior Change Theory that attempts to explain the processes underlying the learning of new health behaviors Health contract/calendar Initial assistance from clinician Relies on self-management capabilities of individual

  26. Recommendations for Healthy Aging Exercise 30 minutes on most days of the week Walking indoors in inclement weather Neighborhoods can contribute to less exercise http://topics.healthvideo.com/m/26757081/exercise-can-help-you-live-longer.htm http://topics.healthvideo.com/m/28352903/volunteering-could-be-healthy-for-the-elderly.htme=healthy-aging&brand_name=healthline Nutrition See Nutrition Bull’s-eye Goal is to consume foods in center

  27. Mental Health • http://medicalnewstoday.healthology.com/hybrid/hybrid-autodetect.aspx?content_id=2516&focus_handle=&brand_name=medicalnewstoday • Life review: autobiography saved in print or on other media • Stronger life satisfaction, promote feeling of well-being, improved self-esteem, reduced depression • Depression • Increases likelihood of death from cancer and heart disease • Suicide: older adults account for 25% of all suicide deaths

  28. Model Health Promotion Programs Healthwise Developed in Boise, Idaho Handbook in 17th edition 190 common health problems Chronic Disease Self-Management Program Nurse researcher at Stanford University SOM Peer-led, community based Project Enhance Enhance fitness Enhance wellness, which focuses on mental health

  29. Model Health Promotion Programs • Ornish Program for Reversing Heart Disease • Vegetarian diet • Fat intake of 10% or less of total calories • Moderate aerobic exercise 3 x/week • Yoga and meditation an hour a day • Support groups • Smoking cessation • Benson’s Mind/Body Medical Institute • MD affiliated with Harvard Medical School • Relaxation response to stress • Proper nutrition and exercise • Reframe negative thinking patterns

  30. Model Health Promotion Programs • Strong for Life • Home based exercise program • For disabled and nondisabled older adults • Focuses on strength and balance • Exercise video, trainer’s manual, and user’s guide

  31. The Boomers • Longest-lived • Best-educated • Healthiest • Most-engaged • Largest cohort of retirees ever • 35 million age 65 or older in 2000 to more than 70 million in 2030

  32. Greenhouses Alternative to nursing homes Robert Wood Johnson Foundation grant Promote autonomy A home environment Own private room and bath Not in all states yet (under development in Akron, CO) Employee turnover rate is much lower than in nursing home Better pay Empowerment 1:5 staff ratio 1:20 RN ratio 1:120 administrator ratio

  33. Watch Video • YouTube • Greenhouse alternative to nursing homes

  34. Chapter 22: Promoting Quality of Life Bonnie M. Wivell, MS, RN, CNS

  35. Quality of Life (QOL) • Definition • Complex concept • Satisfaction/dissatisfaction with life • A person’s sense of well-being • As we age, QOL is dependent on our ability to maintain autonomy and independence

  36. Ferrell and Grant QOL Model

  37. Successful vs. Active Aging • Successful aging: • Person has avoided disease and disease-related disability • Has a high level of cognitive and physical functioning that allows the individual to be engaged with life • Active Aging • Adopted by WHO in the late 1990s • Supports autonomy, independence and activity • Strategies that promote QOL decrease disabilities associate with chronic illness • Increase elders’ participation in the social, cultural, economic, and political aspects of society • Lower the cost of medical treatment • Plan for old age and choose healthy lifestyles

  38. Gender and culture Behavioral Physical activity Nutrition Smoking Alcohol use Medication adherence Personal Genetics and psychological factors Physical environment Neighborhoods and safe housing Social Environment Support Education Literacy Violence Abuse Economic Income Social protection Social Services Health promotion Disease prevention Determinants of Health

  39. The 5 As Ask about use Advise to quit Assess willingness Assist with plan Action (provide help) The 5 Rs Relevance Risks Rewards Roadblocks Repetition Helping the Patient Willing to Quit

  40. Alcoholism in the Elderly • Under-recognized • 1/3 of older alcoholic persons developed the problem later in life • 62% of community dwelling elderly found to drink alcohol • Effects may be increased • Pharmacologic changes associated with aging • Alcohol and drug interactions may be more serious • Physiological changes related to aging can alter the presentation of medical complications of alcoholism • Beneficial but recommended that they limit intake to one drink per day

  41. Alcoholism in the Elderly (cont’d) • Assess for: • Cognitive decline • Non-adherence with appointments • Psychiatric history • Insomnia • Poorly controlled HTN • Frequent falls • GI problems • Nutritional deficiencies • Delirium during hospitalization • CA of the head, neck, esophagus, and liver are associated with chronic alcohol abuse

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